改良Shiraki手术治疗隐匿性阴茎

目的 探讨改良Shiraki手术方法在隐匿性阴茎手术中的意义.方法 自2005年5月至2009年12月间对53例隐匿性阴茎患儿采用改良Shiraki手术进行治疗,其主要手术步骤是:①分别在包皮内板的3点、9点处及外板的6点、12点处纵向切开；②内板与外板分离,在阴茎白膜外层行阴茎皮肤脱套至阴茎根部,同时切除阴茎体外层纤维索带,充分松解阴茎使其完全伸展；③包皮系带横切纵缝成形使包皮内板腹侧延长；④剔除内板皮下水肿的筋膜组织,修剪过宽包皮内板皮瓣,外板尽量保留,然后内外板皮瓣嵌插缝合；⑤置Folay导尿管,用网眼纱布均匀包扎阴茎.结果 术后随访18至24个月,阴茎显露明显改善,较术前延长2～4 cm,阴茎皮肤无坏死.阴茎外形均满意,3例术后阴茎皮肤水肿,3个月后消退,此3例为初期病例；随访1年以上者阴茎肿胀基本消失.结论 采用改良Shiraki手术方法进行包皮延长成形术矫正隐匿性阴茎可获得满意的效果,与Shiraki术式相比其有如下优点:①手术操作简化,易掌握并缩短了手术时间；②皮瓣血供好,切口愈合佳,减少了皮瓣坏死的机会；另外对皮瓣淋巴回流阻断明显减轻,术后阴茎皮肤肿胀情况不明显；③不进行阴茎体固定仍可获得满意的效果,并且避免了阴茎背侧血管神经及尿道的损伤.

Using modified Shiraki operation in the treatment of buried penis

Objective To evaluate the effect of modified Shiraki operation in correcting buried penis.Methods Totally 53 cases of buried penis were treated from May 2005 to December 2009 using modified Shiraki operation.The technique consists of 4 steps:1) is Longitudinal cutting at 3′,9′ of inner prepuce and 6′,12′ of outer prepuce; 2) the seperation of inner and outer prepuce,skin degloving,resection of fibrous tissue and mobilization of divergent corpus spongiosum; 3) transection and longitudinal suture at the frenulum to elongate inner ventral prepuce; 4) remove edematous fascia of the subcutaneous inner prepuce and excise redundant inner prepuce flap,while outer prepuce is preserve as much as possible,with embedding sutures of inner and outer prepuce.Results Postoperative follow-up ranges from 18-24 months.All cases had adequate exposure of the penis,extending in the range of 2-4cm when compared to before surgery.No case had penile skin necrosis.3 cases,at the start of our research,had mild prepuce oedema,which improved after3 months,and disappeared totally after 1 year.Conclusions The modified Shiraki operation is an effective method to correct the pediatric buried penis with a satisfactory outcome.Compared with the original Shiraki method,it has following advantages:①easy to design with shortened operative time; ②Skin flap gets better blood supply,oedema of the penis is reduced,and wound heals faster;③ excellent outcome without fastening the root of the penis,thereby avoiding injury to blood vessel,nerves and urethra in the dorsal penis.